Healthcare Provider Details

I. General information

NPI: 1760470884
Provider Name (Legal Business Name): THOMAS J NORDLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 MADISON AVE
FORT ATKINSON WI
53538-3100
US

IV. Provider business mailing address

1504 MADISON AVE
FORT ATKINSON WI
53538-3100
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-7888
  • Fax: 920-563-7741
Mailing address:
  • Phone: 920-563-7888
  • Fax: 920-563-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number26441
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: